Individual
SHANNON MAURA BRAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5467 CEDAR VILLAGE DR, MASON, OH 45040-8693
(859) 444-0590
Mailing address
113 W 10TH ST, COVINGTON, KY 41011-3016
(859) 444-0590
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
09120
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113
—
OH
Enumeration date
04/29/2021
Last updated
04/29/2021
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